title: Treatment of recalcitrant plaque psoriasis with a humanized non-depleting antibody to CD4.
abstract: The presence of activated CD4(+) T lymphocytes in psoriatic skin plaques suggests an immune-mediated pathogenesis for the disease. Six patients with recalcitrant plaque psoriasis (PASI>12) received a humanized non-depleting monoclonal antibody to CD4 (ORTHOCLONE OKT(R)cdr4a). The antibody was well tolerated. Four weeks from treatment, the mean decrease in PASI score was 46%. In three patients disease remission was prolonged for up to 6 months and, in one case, up to 1 year post-treatment. In all patients, circulating CD4+ T-cell counts remained normal and peripheral OKTcdr4a-coated CD4+ lymphocytes were detected up to 10 days after antibody infusion. These results point to the relevance of CD4+ lymphocytes in psoriasis. They also emphasize that depletion of CD4+ cells is not mandatory to achieve therapeutic effectiveness.
authors.affiliation: Service Dermatologie, Hôpital Saint-Louis, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Bachelez
authors.forename: B
authors.initials: B
authors.lastname: Flageul
authors.forename: L
authors.initials: L
authors.lastname: Dubertret
authors.forename: S
authors.initials: S
authors.lastname: Fraitag
authors.forename: R
authors.initials: R
authors.lastname: Grossman
authors.forename: N
authors.initials: N
authors.lastname: Brousse
authors.forename: D
authors.initials: D
authors.lastname: Poisson
authors.forename: R W
authors.initials: RW
authors.lastname: Knowles
authors.forename: M C
authors.initials: MC
authors.lastname: Wacholtz
authors.forename: T P
authors.initials: TP
authors.lastname: Haverty
authors.forename: L
authors.initials: L
authors.lastname: Chatenoud
authors.forename: J F
authors.initials: JF
authors.lastname: Bach
mesh_terms: D000328:Adult; D000818:Animals; D000888:Antibodies, Anti-Idiotypic / Q000096:biosynthesis; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000235:genetics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015704:CD4 Antigens / Q000097:blood; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008212:Lymphocyte Depletion; D008297:Male; D051379:Mice; D015166:Monitoring, Immunologic; D011565:Psoriasis / Q000276:immunology* / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D012720:Severity of Illness Index; D012867:Skin / Q000737:chemistry / Q000378:metabolism / Q000473:pathology; D013601:T-Lymphocytes / Q000378:metabolism
chemical_list: D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D015704:CD4 Antigens; C079851:OKT4A monoclonal antibody